Provider Demographics
NPI:1013966225
Name:GOCKE, JAMES M (FNP)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:M
Last Name:GOCKE
Suffix:
Gender:M
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:45014 10TH ST W
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:CA
Mailing Address - Zip Code:93534-2371
Mailing Address - Country:US
Mailing Address - Phone:661-942-2391
Mailing Address - Fax:661-723-3769
Practice Address - Street 1:45014 10TH ST W
Practice Address - Street 2:SUITE 109
Practice Address - City:LANCASTER
Practice Address - State:CA
Practice Address - Zip Code:93534-2371
Practice Address - Country:US
Practice Address - Phone:661-942-2391
Practice Address - Fax:661-723-3769
Is Sole Proprietor?:No
Enumeration Date:2006-05-08
Last Update Date:2011-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA429409363LF0000X, 363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
S59433Medicare UPIN
CAWNP7894AMedicare ID - Type Unspecified